Schizophrénie et vieillissement

The variation of functional decline in schizophrenia appears to be higher in late life. The cognitive and functional deficits commonly seen in younger schizophrenic patients appear to worsen in some cases in late life, while other patients appear to have a stable course of illness without functional decline, and still others are reported to have essentially no residual symptoms in their later life. Cognitive and functional deficits appear to worsen more significantly in patients suffering a lifetime course of severe functional deficit.     

Schizophrénie et vieillissement : aspects cliniques

The number of older people with chronic schizophrenia increases and is expected to double over the next two decades. Along with a reduction in positive schizophrenic symptoms with increasing age, a majority suffers from negative symptoms and cognitive deficits. Depression and comorbid medical problems are also frequent. These complex clinical and service needs have to be the focus of interest of psychiatrists to improve quality of care.     

Schizophrénie et violence : comorbidités et typologies

In addition to the clinical factors of the diagnoses of mental pathology in general and schizophrenia in particular, and in addition to the social factors being able to precipitate or contextualise the recourse to the violence of these patients, the question of the comorbidity appears to have to be raised. Indeed, personality disorders, in particular antisocial personality disorder, substances abuse and the comorbidities raise the relevance to wonder about the existence of typologies of patients violent one, understand, envisage and also direct the assumption of responsibility.     

Schizophrénie et violence : facteurs cliniques, infracliniques et sociaux

An abundant international scientific literature is supporting the idea that mental illness is a major risk factor for aggressive and violent behaviours. In addition, schizophrenia is the mental illness, which is over-represented in aggressive and violent behaviours. However, it is not clear to understand the real place of schizophrenia. In particular, some psychopathological signs, seem dominating in the risk of violence, independently of the diagnostic of schizophrenia. in the same way, active phase of the disease, clinical forms, the delirious mechanisms, threat and control-override symptoms, and several other clinical or subclinical factors could play a major role in the relation schizophrenia-violence. This review of the literature proposes to examine these factors to understand the real place of schizophrenia in aggressive and violent behaviours. Mental illness is currently designated as a risk factor of violent behaviours. In order to destigmatise people, just suspected because of the disease, the definition of various clinical dimensions, often independent of diagnoses, likely to precipitate or cause the recourse to violence, don’t appear sufficient. It appears necessary to take into account social or contextual factors, which would explain the recourse to the violence by people suffering of a mental illness. This review of the literature proposes to examine the sociodemographic and socioeconomic factors playing a role in the violence among people having a mental illness in general or a schizophrenia in particular.     

Schizophrénie et société

It is difficult for people suffering from severe mental illness, like schizophrenia, to live normally within the community. Deinstitutionalization (reintegrating society) has been made possible in recent decades by the development of effective drugs. However, stigmatization still occurs. Adapting to daily life is impossible without the help of rehabilitation techniques and community support. Families fully adhere to support and integration.     

Schizophrénie et immigration : influence des facteurs psychosociaux

Introduction

Several studies showed that the prevalence of schizophrenia among immigrants is high. This prompted the authors to investigate the links between schizophrenia and immigration status.

Methodology

We conducted a retrospective study psychiatric service in Mahdia hospital over a period of 5 years and a half from January 2003 to June 2010, including patients hospitalized, diagnosed as having schizophrenia; and having immigration and living abroad experiences.

Results

These 50 male patients of average age 32 years. Forty-two patients (84%) were single. The socioeconomic conditions were low in all cases. Nine patients had familial psychological disorders. Sixteen patients (32%) had a criminal past. Immigration was illegally in 39 cases (78%). Destination countries’ were European in all cases. Duration of immigration was on average 37.3 months. Thirty-one (62%) patients reported experiences of incarceration and experiences of discrimination abroad. The clinical presentation was dominated by disorganized schizophrenia: 37 patients (74%). Eighteen patients (36%) reported drugs consumption. The psychosocial stress was according to DSM IV-TR, professional problems and problems related to social environment.

Conclusion

It seems that besides the biological and neuro-developmental schizophrenia hypotheses, there are psycho-social hypotheses: social stress. Other studies are needed to support these hypotheses.     

Reconnaissance de l’émotion faciale et schizophrénie

A broad range of deficits in interpersonal skills characterizes schizophrenia. A natural way to tackle these deficits is to explore the ability of schizophrenic patients to process stimuli that have a well-established psychosocial content: faces, for instance. Schizophrenia deficits in facial recognition and discrimination have been studied extensively and most investigators have pointed out that patients with schizophrenia perform less well than non-patients and psychiatric controls in numerous facial paradigms, including facial identity, emotion and age recognition tests. The extent of the schizophrenic deficit suggests the alteration of a processing mechanism common to all kinds of facial information and the configural information extraction process has then been regarded as a probable candidate. Nevertheless, only a few studies directly tested the hypothesis. In what follows, we draw a general schema of the schizophrenia deficit in facial processing, next we present a series of studies investigating the putative implication of configural information in the abnormal processing of facial emotion in the disease.     

Schizophrénie et double parricide : à propos d'une observation clinique

Parricide has always been considered as the most appalling, rarest and most unnatural crime ever. Among the adults that have committed parricide, numerous of them are mentally ill. This incredible story of a schizophrenic responsible for committing double parricide, enables us to understand the dimensions conductive to crime related to delirious and paranoid states. In more general terms, this example opens the debate on the problems posed in approaching a prognostic and prevention of psychotic's violent acts. On the 25th December, Christmas day, feeling lonely and abandoned by everyone, A. calls his parents asking them to come to his home. Scared by previous violent incidents involving their son, they decide to go there accompanied by A's uncle, and ring on the bell. A. greets them on the side-walk, and seeming already “tolerably” agitated and unsteady, he offers a meticulously wrapped present to his father, which proves to be a loaded hunting gun. Confronted by his fathers refusal to accept the present, A. opens the package and kills him father firing two gunshots in his chest, then proceeded to fire at close range on his mother, killing her by a shot her in the abdomen. The uncle, now injured in the shoulder, manages to escape. As a result of this double murder, A. is questioned by the police. As consequence of faced with his delirious account, he is hospitalised immediately. How could such a terrible tragedy occur? At the time of the act, A. is 27 years old. His schooling is marked by early difficulties and instability, as is his professional experience, which only consists of various “small” jobs. He blames these failures on his parent's frequent disputes, who finally end up in divorce. This represents a real trauma for A., on which he crystallises the entirety of his suffering, which is fuelled by his persecutive delirium based on his past and lived experiences. In the preceding five years leading up to the murder, A. had been hospitalised for psychiatric care on four occasions, all linked with violence perpetrated on his mother. These all took place in a state of delirium, with themes of persecution and interpretation. Some examples including : “My parent's made a prostitute of my sister… They used me for the psychiatric services… I mustn't be hospitalised again, they practice vivisection on their patients… My mother used to insult me… She has been transformed and manipulated by the medical services… She has the strength of the devil…” clearly show us the active and targeted persecution and suffering ; violence is used in an effort to put an end to this. However, A's patch of violence does not stop within the family group. He has been involved, on two separate occasions with the law. Firstly, after a fight, for which he has not convicted, and secondly, for grievous bodily harm along with death threats and arson. For the latter, he was convicted following a psychiatric assessment, and served 15 months imprisonment with compulsory psychiatric treatment. All these measures do not stop such a tragedy occurring, after which, in accordance to clause D 398 of the French Procedure Penal Code, A. is hospitalised immediately. In accordance with two psychiatric assessments, the judge pronounces a decision of nonsuit in applying the French Penal Code clause 122-1 alinea 1. During his hospitalisation, and despite his transfer into UMD. “Unité pour Malades Difficiles” (Psychiatric Unit accepting dangerous mentally ill patients) and even if the delirium declines, with the effects of chemotherapy, psychotherapy and institutionalisation, A. remains potentially highly dangerous. He continues to be only superficially aware of his parricidal acts, represses his delirium and actively denies his pathology. Here we can see that mental illness occupies the preponderant place in the origin and dynamic in committing violent acts. The persecutive delirium, violence and denial (symptoms of mental dissociation) give a clinical explanation to this act, which is usually reputated among the most incomprehensible. This typical case of dangerous delirious schizophrenia illustrates once again the necessity not to underestimate the extremely clear and recurring signs of danger (lived experience, delirious directive speech, the generated pain and desire to end the suffering and alleged prejudices, all bringing about aggressive action…). These negative emotions aroused by deliriums of prejudice and persecution most often risk, and we insist of this point, a provocation of pathological self-defensive attitudes and behaviour. These are defensive, avoidance reactions or escape, or, as we saw with A., aggression against “the persecutors”. This violent acts are destined to control or stop the source of persecutive feelings. Constrained hospitalisation, even at long term if necessary, with constant and regular checks of chemical and psychotherapeutic treatment are curative and preventive measures which should be compulsory to avoid this type of tragedy.     

Mortalité et surmortalité dans la schizophrénie

The aim of the present communication is to present an overview on mortality in schizophrenic patients. Recent meta-analyses have confirmed high rates of mortality in schizophrenic patients and, notably, the gap observed in the last three decades between mortality in the general population and that of schizophrenic patients. In this population mortality rates due to non-natural causes, essentially suicide, are 12 times higher than that of the general population, natural causes of mortality being due to cardiovascular and respiratory diseases. Atypical antipsychotics have been incriminated in the high rate of mortality among schizophrenic patients. Prevention was focused firstly on a decrease of the risk of suicide and secondly on poor living habits (smoking, obesity). The importance of a regular follow-up of the somatic health of schizophrenic patients was discussed.     

Étude des représentations sociales de la schizophrénie dans la population générale et dans une population de patients schizophrènes

This study aims to compare social representations of schizophrenia in a sample of schizophrenics patients and in the general population. This question is of considerable interest in clinical practice and in psychosocial intervention. On the one hand, most of the schizophrenics patients have been informed about their diagnosis. On the other hand it is well known that stigmatisation attached to the labeling of schizophrenia has major repercussions on the acceptation of the diagnosis for the patient and his family, the compliance to treatment and the quality of life. Understanding social representations of schizophrenia in a sample of schizophrenics may be useful in adapting psychoeducation techniques and preventing relapses. We have investigated these reprentations in a sample of 20 schizophrenics who were informed of their diagnosis and in a 20 matched sample in the general population. We have excluded the persons who had a previous contact with a schizophrenic. Results show that medical representations of the trouble occur in general population, which can be considered as a positive evolution of the representation of schizophrenic people who are considered as ill persons rather than just “mad”. With regard to stigmatising representations, it is surprising to note that schizophrenics and the general population share the same representations. We hypothesize that this attitude in schizophrenics may result from an internalization of the supposed stigmatisation about their illness.     

Schizophrénie et réadaptation. Interventions spécifiques selon les phases de la maladie

This article briefly overviews the main interventions available for the rehabilitation processes in patients suffering from schizophrenia. Each intervention mode is exposed with regards to the evolution stage, from the first psychotic episode to the relapse prevention phase. The psychosocial resources (family, community, individual) that can be called upon in the rehabilitation period are dealt with more precisely. Special attention was also given to the main cognitive behaviour therapies currently used in the treatment of psychosis.     

Hypothermie aux antipsychotiques : particularités chez le sujet âgé souffrant de schizophrénie

Hypothermia - an adverse drug reaction of antipsychotic drug use potentially severe - seems less well-known than the hyperthermic effects (for example, malignant neuroleptic syndrome) and thus underdiagnosed. Thermoregulation in elderly can be altered. Additionally, some patients suffering from schizophrenia are not able to control their own environment or physical status. Thus, risk factors for hypothermia must be identified and frequent measurements of body temperature must be performed in order to detect developing hypothermia. A case report of hypothermia in a 69 years old patient suffering from schizophrenia is published with this review.     

Déterminants génétiques des idées délirantes

The use of symptom dimensions of schizophrenia (positive, negative and disorganised) as quantitative phenotypes has been proposed as a mean to reduce the heterogeneity of schizophrenia and facilitate genetic research. The aim of the present study was to summarize the results of studies investigating the genetic background of the positive dimension. Several studies suggest a genetic contribution to the reality distortion dimension, but at a lesser degree than for the disorganised dimension. Few studies have investigated relationships between genetic factors and reality distortion dimension. However, some works suggest that genetic variation in DISC1 and COMT may be associated with delusions and hallucinations. As specific cognitive deficits have been suggested as explanations for the positive dimension, new strategies should focused on their correlations with genetic factors. For example, source-monitoring deficits (a presumed cognitive marker for increased proneness to psychotic symptoms) can be observed in subjects with 22q11 deletion syndrome, a region containing candidate genes such as Catechol-O-Methyltransferase (COMT) gene.     

Production d’émotions faciales dans la schizophrénie

Converging evidences revealed that facial pattern recognition is severely impaired in schizophrenia. The present article focuses on recognition of their own facial expression by patients with schizophrenia. It seems that schizophrenia is related with a dissociation between facial expression and emotional feeling. Recent experimental data are discussed.